Chronic Pain

Dear Ashley,
I know that pain is probably your most persistent and limiting symptom, and I'm sorry that with all advances in medical technology, nothing can fix it.  It must be so frustrating to have doctors perform all these complex and intricate tests and they can't even solve the most basic problem of being in pain.  I know you have tried so many pain management strategies since this all began, and it's possible none of these ideas will work for you.  If that's the case, I would be happy to keep sifting through the research to find other strategies that have worked for patients in the past.  
I just want to say that your ability to keep smiling even when everything hurts is inspirational to me, so thank you.
-Amanda

Chronic pain related to joint inflammation secondary to an unknown pathophysiologic process as evidenced by reports of pain lasting longer than 6 months. 

• Assess pain with a scale specific to her, so she can compare her pain day by day and month by month in the way she is experiencing it.  A standard scale used for acute pain patients in a hospital setting is likely not specific enough to address her challenges (Fortney, 2012). 
• Assess for complications of chronic pain.  Depression symptoms are common, secondary to unresolved chronic pain (Carpenito-Moyet, 2010). 
• Assess coping strategies to manage pain, and help build upon these and encourage growth in the areas that are  lacking (Peres & Lucchetti, 2010).  Different individuals cope in different ways, and providers should facilitate the search for enhanced coping (Peres & Lucchetti, 2010).
• Limit use of opioids.  These may lead to dependence, worsening pain problems, and may not be effective against chronic pain (Fortney, 2012).  Consider them only for short-term use, for break-through pain that cannot be managed any other way (Fortney, 2012).  
• Encourage low impact exercise, which can improve stiffness and increase endorphin levels (Selby, 2011).
• Provide emotional support.  Sometimes this is the last available option when pharmacologic and non-pharmacologic strategies are insufficient.  Because I am not Ashley’s health care provider in person, this is one way I can be there for her (Carpenito-Moyet, 2010). 
• Teach relaxation techniques as she finds them effective.  She mentioned that after seeing a pain specialist, she found this helpful on some occasions, but not consistently (Selby, 2011). 
• Refer to a pain clinic. Ashley found the emotional support to be helpful, but many of the non-pharmacologic pain relief strategies to be insufficient.